Benjamin Button - 56

XIII.
DOCTOR’S ORDER
Date & Time Progress Date &

Notes Time Medical
Ordered Order Rationale Remarks
August 31, 2018 August 31, -Please admit -Dr. Caballes is the Attending -Admitted under
Ht – 172 cm 2018 patient under the Physician and is in charge of the Dr. Caballes’
Wt – 64 kg service of Dr. patient service.
T – 38 C Caballes.
P – 107 bpm
HR- 112 bpm
R – 26 cpm -Secure consent -For legal purposes -Secured consent
BP – 140/90 mmHg to care to care
SPO2 – 96 %
CBG – 90 -Low Salt Low -Following this helps keep high
CC – Dyspnea Fat diet blood pressure and swelling under -Patient followed
7 days prior to control LSLF diet
admission, patient had
productive cough with -They determine which treatment
yellowish sputum, no -Vsq 4 hours protocols to follow, provide critical -VS were taken
meds, no consult done. information needed to make life- q4
1 day prior to admission, saving decisions, and confirm
patient had onset of feedback treatments performed.
right sided chest pain
radiating to the back,
10/10 pain scale
associated with feeling -To help evaluate a patient’s fluid
of heaviness on chest, -I & O q shift and electrolyte imbalance, to -I&O was
cough and pleuritic suggest various diagnoses and monitored every
chest pain. Patient was allow prompt intervention to shift.
then rushed to the ER correct any imbalances.
56
and was managed as a
case of CAP Low Risk
Hypertension
Stage 1. Given NAC, -IVF: PNSS 1 L -PNSS is used because it has little -Patient was
Azithromycin and @ 60 cc/hr to no effect on the tissues and given PNSS
Dolcet with temporary makes the patient feel hydrated,
relief. preventing hypovolemic shock or
7 hours prior to hypotension.
admission, patient had
sudden onset of dyspnea
on rest, no associated >Labs: -To provide valuable diagnostic -Patient was able
symptoms persistence of -CBC information regarding overall to comply all his
symptoms. Prompted, health of the patient and the labs.
consulted and confirmed patient’s response to disease and
admission. treatment.
Medical History: -Serum Crea -To evaluate kidney function in a

Hypertensive with wide range of circumstances, to
Losartan 100 mg since help diagnose kidney disease and
2013. to monitor people with acute or
(-) Bronchial Asthma chronic kidney failure.
2013 Cardiac Arrest -Serum
2014 Psoriasis Electrolytes (Na, -Sodium: To maintain homeostasis
K, Ca, Mg) in a variety of ways, including
(+) smoker 1 pack per maintainig the osmotic pressure of
day ECF, regulating renal retention and
(+) alcoholic drinker 1 excretion of water, maintaining
bottle per day acid-base balance, regulating
potassium and chloride levels,
(+) 3 pillow for dyspnea stimulating neuromuscular
(-) dysuria reactions and maintaining systemic
57
(-) hematuria blood pressure.
(-) melena -Potassium: To maintain acid-base
(-) heat and cold equilibrium, and it has a significant
intolerance and inverse relationship to pH: A
PE: decrease in pH of 0.1 increases the
awake, conscious, potassium level by 0.6 mEq/L.
coherent, not in -Magnesium: For transmission of
respiratory distress, nerve impulses and muscle
anicteric sclera, pink relaxation.
palpebral conjunctiva, -Calcium: used to measure the
moist mucosa total amount of calcium in your
(-) Cervical lymph blood. It is important for heart
adenopathy function, and helps with muscle
Equal chest expansion contraction, nerve signaling and
(+) bilateral crackles blood clotting.
Adynamic precordium
(-) murmur -CXR, 12 lead -Yields information about the
Soft, non-tender ECG pulmonary, cardiac, and skeletal
abdomen systems.
Capillary refill time >2
Full pulses
-Sputum GSCS -To diagnose a bacterial infection
Impression: in the patient’s respiratory tract.
Hypertensive
Cardiovascular Disease, Medications:
Coronary Artery -Losartan -It is used to treat high blood -Patient was able
Disease, Cardiac 100mg/tab one pressure. to comply with
Arrythmia, tab once a day all his meds.
Preventicular
contractions, Congestive
Heart Failure, FC II
58
(+)LVH -Fenofibrate 160 -Used to help lower bad cholesterol
(-) LVD mg / cap 1 tab and fats (LDL, Triglycerides) and
CAP MR OD raise good cholesterol (HDL) in the
Hypertension stage 1 – blood.
controlled
-Paracetamol -It is used to relieve mild or

500mg/tab one moderate pain and reduces fevers.
tab every 6
hours
-Used to help lower bad cholesterol

-Atorvastatin 20 and fats (LDL, Triglycerides) and
mg/tab OD raise good cholesterol (HDL) in the
blood.
-Azithromycin -Used to treat different types of

500 mg/tab OD infections caused by bacteria.
for 4 days
-Acetylcysteine -Used for chest pain (unstable

600 mg per tab angina), to treat paracetamol
with ½ glass overdose and to loosen thick
water OD mucus in individuals with cystic
fibrosis or COPD.
59
-Dolcet tab/ 1 -To treat moderate to severe pain,
tab 3x a day joint pain, toothache, headache and
other conditions.
-Co-amixoclav -Used to treat infections caused by

1.2 g IVTT q 8 certain bacteria.
hours
-Will inform -To let the attending physician -Attending

attending know about this admission physician was
physician of this informed.
admission.
-Please inform
medical resident -It is important for the medical
on duty once in resident to know the patient -Medical
room assigned to him/her and for resident was
him/her to follow up to the informed.
attending physician
-Follow up chest -Yields information about the -Chest xray

xray result pulmonary, cardiac, and skeletal result was being
systems. followed up.
60
Receiving notes September 1, -Facilitate -To diagnose a bacterial infection -Sputum gscs
September 1, 2018 2018 sputum gscs in the patient’s respiratory tract was being
7 am facilitated.
(+) chest pain,
squeezing in character -Continue meds -To continue cycle -Medications
radiating to the right were continued.
lower back, with a pain
scale of 10/10 -Refer
(-)dyspnea accordingly -For further management -It was referred
(-) fever accordingly
(+) cough
Awake, not in distress
Bilateral Crackles -O2 @ 1-2L/min -To relieve patient from dyspnea -O2 was given
Soft abdomen via nasal via nc prn for
Full pulses cannula PRN for dyspnea
To consider acute dyspnea
coronary syndrome
Sinus rhythm with
occasional pvc -ECG 12 leads -To check for signs of heart disease -ECG was done
now
September 1, 2018 7 AM -Hook to cardiac -To continuous monitor the heart’s -Patient was
In chest discomfort @ monitor activity. hooked to a
right lower chest cardiac monitor
radiating to right lower
back, no point -Plan: Trop I if -To detect whether or not patient is -Trop I is asked
tenderness okay with AP experiencing heart attack. to the AP if
(+) difficulty of okay.
breathing
(-)fever
61
(-) LBM or vomiting -Maintain O2 -To ease patient from breathing -O2 was
Productive cough with @1-2 L/min maintained.
whitish sputum
Confirmed with
Dr. Caballes
-Isordil 5mg/tab -Used to dilate blood vessels,

1 tab sublingual making it easier for blood to flow -Isodril was
now through them and easier for the given
heart to pump sublingually.
Awake, responsive, not

in respiratory distress, >Pending labs:
with bilateral crackles,
tight chest wheezing, -Chest Xray -Yields information about the -Chest xray was
regular rhythm, no results pulmonary, cardiac, and skeletal followed up.
murmur, soft non tender systems.
abdomen
Not distended
Full pulses -Sputum CS -To diagnose a bacterial infection -Sputum cs was
With edema in the patient’s respiratory tract. followed up.
Occasional pvcs
CAP MR
DM 2 -Plan: For -Allows the doctor to monitor how -AP was asked if
CKD secondary to 2DECHO if the patient’s heart and its valves 2DECHO is
Diabetic Kidney Disease okay with AP are functioning. okay for the
Hypertension patient.
*Azithromycin Day 2
*Co-amoxiclav Day 0
plus 2 doses
62
-Lipid profile if -To measure the amount of good -Lipid profile
okay with AP and bad cholesterol and was asked to AP
triglycerides. if okay
-To include -This is to help doctors evaluate -ALT was

ALT (Alanine patient’s liver function or included
Aminotransferas determine the underlying cause of
e test) a liver
-Plan to increase -Used to help lower bad cholesterol -Atorvastatin

Atorvastatin to and fats (LDL, Triglycerides) and was increased to
80mg/tab once a raise good cholesterol (HDL) in the 80mg/tab once a
day at hours of blood. day
sleep, if normal
ALT
-Plan to start -To prevent heart attacks and -Asked the AP if

Clopidogrel 75 strokes in persons with heart okay to start
mg/tab once a disease, recent stroke or blood Clopidogrel 75
day circulation disease. mg/tab once a
day
63
-Will update Dr. -For Dr. Caballes to be updated -Dr. Caballes
Caballes with the patient’s condition. was updated.
Rounds with Dr.

9:40 AM Caballes
-2DECHO -Allows the doctor to monitor how -2DECHO was
the patient’s heart and its valves done
are functioning
-Start Berodual -Used to treat or prevent -Berodual was

meds every 6 bronchospasm of the patient. started.
hours
-Norgesic Forte -To help relax certain muscles in -Norgesic Forte

tab TID round the body and relieve pain and was given.
the clock discomfort caused by strains,
sprains, or other injury to the
muscles.
-Follow up -To diagnose a bacterial infection -Sputum cs was

sputum cs in the patient’s respiratory tract followed up.
-Imdur 30 -Used to prevent chest pain in -Imdur 30mg/tab

mg/tab one tab patients with a certain heart one tab on 8pm
on 8pm condition. was give.
64
-Discontinue -The heart’s condition was already -Cardiac monitor
Cardiac monitor seen, thus it’s okay to discontinue. was
discontinued.
-Clopidogrel 75 -Used to prevent heart attacks and -Clopidogrel was

mg/tab one tab strokes in persons with heart given.
once a day every disease.
-Vs after nebulization: 1PM
BP: 140/80
HR: 100
CR: 73 -Give Berodual -Used to treat or prevent -Berodual neb
SPO2: 98% neb every 20 bronchospasm in asthma and was given.
With wheezing on both mins x2 more COPD.
lung fields doses
Still with difficulty of
breathing
(+) vomiting x 1
episode, whitish vomitus -VS every hour -To have the patient closely -VS was taken
No abdominal pain monitored. every hour.
-Facilitate -Allows the doctor to monitor how -2DECHO was

2DECHO to get the patient’s heart and its valves facilitated.
initial result of are functioning
ejection fraction
65
ABG – partially -ABG stat -To measure the acidity or pH and -ABG was
compensated metabolic levels of O2 and CO2 from an measured stat.
acidosis artery.
pH – 7.31 -Give -To relieve symptoms such as -Metoclopramide

pCO2 – 34 Metoclopramide nausea, vomiting, heartburn, a was given.
HCO2 – 17.1 10mg IV now feeling of fullness after meals and
PO2 – 68 loss of appetite.
SO2 – 91 %
(+) Still with mid to

base crackles, THS -Increase O2
regular rhythm inhalation to 4 L -To ease the patient from difficulty -O2 was
(-) murmur per min of breathing. increased.
Full pulses
Pulmonary congestion
-Stat NaHCO3
Ejection Fraction: 38% / 2:30 PM 650g/tab one tab -To reduce stomach acid -NaHCO3 was
24% / 46% thrice a day given.
(-) Difficulty of
breathing -Give another -Used to treat fluid retention -Furosemide was
(-) Chest pain Furosemide (edema) in people with congestive given.
(-) Vomiting 20mg IV now heart failure, liver disease, or a
Decrease crackles kidney disorder such as nephrotic
syndrome.
66
-Co-Amox day 1
-Azithromycin day 2 -Will update Dr. -To inform AP about the updates -Dr. Caballes
Vital signs: Caballes of the patient. was updated.
BP: 120-140/70-90
HR: 86 – 98
T: 36 – 36.4 -Plan: Trop I if -To detect whether or not patient is -AP was asked if
RR: 20-22 okay with AP experiencing heart attack. Trop I is okay.
O2 sat – 96-98 %
S: (-) Chest pain

(-) dyspnea September 2, -Maintain IVF -To prevent central line occlusions -IVF was
(-) febrile episode 2018 to KVO and any associated delays in care maintained to
(-)productive cough 12:40 AM KVO rate.
O: GCS 15
-Not in respiratory -Maintain on
distress Moderate High -To facilitate easy breathing. To -Patient was
-Pink palpable Back Rest promote oxygenation via maintained on
conjunctiva maximum chest expansion. MHBR.
-Regular Cardiac rate
and rhythm -Maintain on O2 -To increase amount of O2 in the -O2 was
(+) bilateral crackles at 4L/M patient’s lungs receive and deliver maintained at
Full pulses to the blood. 4L/M
Capillary refill time: less
than 2 seconds
A: Pulmonary -Follow up -Allows the doctor to monitor how -Pending labs
Congestion 2 to HF with pending labs: the patient’s heart and its valves were followed
EF (-) LVH PVCs CAP -2DECHO are functioning. up.
MR CKD 2
Hypertensive
Nephroschelorosis
P: Relief of pulmonary
67
congestion -Sputum gscs -To diagnose a bacterial infection
-CHF regimen in the patient’s respiratory tract.
-antibiotic courage
-CVD regimen
-BP control and heart -Facilitate lipid - To measure the amount of good
rate control profile and bad cholesterol and
triglycerides.
-Serum uric -Serum uric acid: To determine

acid, ALT how much uric acid is present in
routine the blood.
-ALT routine: This is to help
doctors evaluate liver function or
determine the underlying cause of
a liver
-Suggest repeat - Sodium: To maintain

Na, K, Mg, homeostasis in a variety of ways,
regarding the including maintainig the osmotic
Premature pressure of ECF, regulating renal
ventricular retention and excretion of water,
contractions maintaining acid-base balance,
regulating potassium and chloride
levels, stimulating neuromuscular
reactions and maintaining systemic
blood pressure.
-Potassium: To maintain acid-base
equilibrium, and it has a significant
and inverse relationship to pH: A
68
decrease in pH of 0.1 increases the
potassium level by 0.6 mEq/L.
-Magnesium: For transmission of
nerve impulses and muscle
relaxation.
-Calcium: used to measure the
total amount of calcium in your
blood. It is important for heart
function, and helps with muscle
contraction, nerve signaling and
blood clotting.
-Continue meds -To continue cycle -Medications

were continued.
-Continue -To be updated on the patient’s -Monitoring was

monitoring condition continued.
-Will update Dr. -To inform AP about the updates -Dr. Caballes
Caballes of the patient was updated.
-Refer -For further management -Patient was

referred.
-Will start -Used to treat fluid retention
Furosemide 28 (Edema) in people with congestive -Furosemide was
mg IV every 8 heart failure, liver disease or started.
hours if okay kidney disorder such as nephrotic
with AP syndrome.
69
Rounds with Dr.
Caballes
-VS every 4 -They determine which treatment -VS was taken

hours protocols to follow, provide critical every 4 hours.
information needed to make life-
saving decisions, and confirm
feedback treatments performed
-Decrease -To diagnose a bacterial infection -Berodual neb

Berodual neb to in the patient’s respiratory tract. was decreased.
1 neb to every 6
hours PRN
-Follow up -Sputum culture

sputum culture -To know the results and relay it to was followed up
and relay results the AP. and results were
relayed.
-Decrease
Norgesic Forte 1 -To improve myocardial glucose -Norgesic Forte
tab TID to PRN utilization through inhibition of was being
fatty acid metabolism decreased.
-Decrease .
Dolcet 1 tab -This is used to treat stable angina
every 6 hours to pectoris, chest pain caused by -Dolcet was
PRN decreased oxygen supply due to decreased
reduced blood flow to the heart
70
-Facilitate lipid - Lipid profile: To measure the -Lipid profile,
profile, serum amount of good and bad serum uric acid
uric acid and cholesterol and triglycerides. and ALT were
ALT -Serum uric acid: To determine facilitated.
how much uric acid is present in
the blood.
-ALT routine: This is to help
doctors evaluate liver function or
determine the underlying cause of
a liver.
3:30 PM -Please follow -Yields information about the -Chest xray was
up chest xray pulmonary, cardiac, and skeletal followed up.
result systems.
-Discontinue -Since the patient had a reaction to

Acetyl Cysteine acetyl cysteine, thus it is -Acetyl Cysteine
discontinued and berodual is used was
instead discontinued.
-Azithromycin -Used to treat different types of -Azithromycin

day 3 infections caused by bacteria. was taken.
71
-Co-amoxiclav -Used to treat infections caused by -Co-Amoxiclave
S: (-) Chest pain day 2 plus 2 certain bacteria. was taken
(-) dyspnea doses
(-) febrile episode
(-)productive cough
O: GCS 15 Pending labs: -Lipid profile: To measure the -Pending labs
-Not in respiratory -Lipid profile, amount of good and bad were followed
distress serum uric acid, cholesterol and triglycerides. up
-Pink palpable ALT -Serum uric acid: To determine
conjunctiva -Chest xray how much uric acid is present in
-Regular Cardiac rate -Sputum gscs the blood.
and rhythm -2DECHO -ALT routine: This is to help
(+) bilateral crackles doctors evaluate liver function or
Full pulses determine the underlying cause of
Capillary refill time: less a liver.
than 2 seconds -Chest xray: Yields information
A: Pulmonary about the pulmonary, cardiac, and
Congestion 2 to HF with skeletal systems.
EF (-) LVH PVCs CAP -Sputum gscs: -To diagnose a
MR CKD 2 bacterial infection in the patient’s
Hypertensive respiratory tract.
Nephroschelorosis -2DECHO: Allows the doctor to
P: Relief of pulmonary monitor how the patient’s heart and
congestion its valves are functioning.
-CHF regimen
-antibiotic courage
-CVD regimen
-BP control and heart
rate control September 3, -Resume -To ease patient’s breathing -Nebulization
2018 nebulization was resumed.
9:30 AM Berodual three
72
times a day
-Please attach -To follow up sputum cs result -Sputum cs

sputum cs result result was
attached.
-Hold -Patient’s cholesterol level is -Atorvastatine

Atorvastatin normal, atorvastatin is on hold was on hold.
because this drug is used to
improve cholesterol levels.
-Follow up
ultrasound of -Ultrasound of
liver and -To let the AP further manage the the liver and
Hepatobiliary patient’s condition HBT was
tract followed up.
73
XIV. LABORATORY TESTS
Hematology
Date Received: August 31, 2018, 6:17 PM
Date Reported and Released: August 31, 2018, 6:19 PM
Results Reference Justification Nursing

Range Responsibilities
Complete 1. Monitor the
Blood Count White blood cells are patient’s intake and
WBC Count 10.69 x 5-10 g/L our body's first line of output and vital
10^3/uL defense against signs before and
(H) invading bacteria and after laboratory and
most other harmful diagnostic tests and
organisms. at specific interval.
An increase in WBC Report changes
is a sign of presence immediately to the
of infection stress, physician.
inflammation, trauma,
allergy or certain 2. Explain to the
diseases of the patient. patient’s mother and
the family members
the purpose for the
laboratory and
diagnostic tests
briefly. A detailed
explanation during
crisis may be
appropriate.
3. Explain the
74
procedure to the
patient’s mother
involving use of the
tourniquet.
4. Obtain blood
sample collection
and send to the
laboratory
immediately. Check
that results are
returned and notify
the physician of the
laboratory results.
5. Instruct the
patient’s mother that
her child may eat
and drink before the
test.
6. Assess for history

of drug use or
treatment modalities
that may cause
immunosuppression.
Hemoglobin 131 g/L 140-180 g/L Hemoglobin’s

(L) function is to transport
oxygen to the cells
and to remove carbon
75
dioxide from them for
excretion by the lungs.
When a patient’s
hemoglobin count is
low this may indicate
that he has anemia,
which is a condition
that develops when
patient’s blood lacks
enough healthy RBCs.
Hematocrit 0.38 0.40-0.60 Hematocrit is the ratio
(L) of the volume of
RBCs to the total
volume of blood.
Low hematocrit may
cause bleeding,
destruction of RBCs
(sickle cell anemia,
enlarged spleen),
decreased production
of RBCs, nutritional
problems (low iron,
B12, folate and
malnutrition), and
overhydration
RBC Count 4.58 x 4.0 – 6.00 x Normal
10^6/uL 10^12/L
Differential It is used as an
Count indicator of immune
status because it
76
Neutrophil 0.69 0.45-0.65 reflects the type and
number of WBC
(H) available to rapidly
respond to an
infection, thus the
patient has infection.
Lymphocytes 0.16 0.20-0.35 Lymphocytes play an
(L) important role in the
body’s natural defense
system. Since the
patient has a low
lymphocytes and has a
high neutrophil then
the body is fighting
for infection.
Monocytes 0.10 0.02-0.06 % An increased number
(H) of monocytes occurs
because of the body’s
response to the
chronic infections.
Eosinophil 0.05 0.00-0.04 It helps protect the

(H) body against disease
and infections by
moving around and
eating some types of
bacteria, foreign
substances, and other
cells.
When a patient is
having a high
77
eosinophil level this
means that the body is
sending more WBC to
fight off infections.
Basophil 0.00 0.00-0.01 Normal
Platelet Count 191 150-450 x Normal
x10^3/L 10^9/L
Clinical Chemistry
Date Received: September 1, 2018, 7:22 AM
LIPID Results Reference Range Justification

Cholesterol 3.66 mmol/L 0.00 – 5.20 mmol/L Normal
Triglycerides 1.06 mmol/L 0.00-1.70 mmol/L Normal
HDL 0.83 mmol/L 1.00-1.55 mmol/L HDL has an

(High Density (L) important role that
Lipoprotein) removes LDL
Cholesterol from the
walls of the arteries,
thus it protects the
arteries from
clogging. So if a
patient’s HDL is low,
this means that I
cannot protect the
arteries from causing
conditions like heart
attack or stroke.
78
LDL
(Low-Density 2.3 mmol/L 0.0 – 4.7 mmol/L Normal
Lipoproteins)
Uric Acid 0.48 0.16-0.43 The kidney is where
uric acid is filtered.
(H) Since the patient has
CKD, this means that
his kidney is
damaged, thus uric
acid carried from the
blood, cannot pass
through the kidneys.
SGPT (ALT) 617 0.00-24U/L The patient’s liver is
Serum Glutamic (H) damaged, thus liver
Pyruvic cells are spill these
Transaminase(Alanine enzymes into the
Aminotransferase blood, thus resulting
Test) to a high ALT result.
Clinical Chemistry
Date Performed: August 31, 2018 6:59 PM
Results Reference Range Justification

Sodium 145.7 135.00-148.00 Normal
Magnesium 0.94 mmol/L 0.74-0.99 BUN is done to see
how well your
kidneys are working,
if they are not able to
remove urea from the
blood normally, BUN
79
rises.
Heart failure,
dehydration or a diet
high in protein can
also make it higher.
Creatinine 897.0/ umol/L 57-113 Creatinine is the end
(H) product of creatine
metabolism. The
amount of creatinine
generated in an
individual is
proportional to the
mass of the skeletal
muscle present.
High creatinine level
signifies impaired
kidney function or
kidney disease.
(Level of muscular
activity is not a
critical determinant.).
Potassium 4.6 mmol/L 3.6-5.1 Normal
Calcium 1.22 mmol/L 1.13-1.32 Normal
80
XV. DRUG STUDY
LOSARTAN
Generic Name LOSARTAN
POTASSIUM
Brand Name Cozaar
Classification CARDIOVASCULAR AGENT; ANGIOTENSIN II RECEPTOR

ANTAGONIST; ANTIHYPERTENSIVE
General Action Angiotensin II receptor (type AT1) antagonist acts as a potent
vasoconstrictor and primary vasoactive hormone of the renin–angiotensin–
aldosterone system.
Dose and Route Hypertension
Adult: PO 25–50 mg in 1–2 divided doses (max: 100 mg/d); start with 25
mg/d if volume depleted (i.e., on diuretics)
Indications or Selectively blocks the binding of angiotensin II to the AT1 receptors found
Purposes in many tissues (e.g., vascular smooth muscle, adrenal glands).
Antihypertensive effect results from blocking the vasoconstricting and
aldosterone-secreting effects of angiotensin II.
Side effects CNS: Dizziness, insomnia, headache.
GI: Diarrhea, dyspepsia.
Musculoskeletal: Muscle cramps, myalgia, back or leg pain.
81
Respiratory: Nasal congestion, cough, upper respiratory infection, sinusitis.
Contraindications Hypersensitivity to losartan, pregnancy [category C (first trimester),
category D (second and third trimesters)], lactation.
Nursing Assessment & Drug Effects
Responsibilities
 Monitor BP at drug trough (prior to a scheduled dose).
 Monitor drug effectiveness, especially in African-Americans when
losartan is used as monotherapy.
 Inadequate response may be improved by splitting the daily dose
into twice-daily dose.
 Lab tests: Monitor CBC, electrolytes, liver & kidney function with
long-term therapy.
Patient & Family Education
 Notify physician of symptoms of hypotension (e.g., dizziness,

fainting).
 Notify physician immediately of pregnancy.
 Do not breast feed while taking this drug.
82
FENOFIBRATE
Generic Name FENOFIBRATE
Brand Name Tricor, Luxacor,
Lofibra, Antara
Classification CARDIOVASCULAR AGENT; ANTILIPEMIC

General Action Fibric acid derivative with lipid-regulating properties. Lowers plasma
triglycerides apparently by inhibiting triglyceride synthesis and, as a result,
lowers VLDL production as well as stimulates the catabolism of
triglyceride-rich lipoprotein (e.g., VLDL). Produces a moderate increase in
HDL cholesterol levels in most patients.
Dose and Route Hypertriglyceridemia
Adult: PO 54 mg q.d. (max: 160 mg/d)
Indications or Adjunctive therapy to diet for patients with high triglycerides.

Purposes
Side effects Body as a Whole: Asthenia, fatigue, infections, flu-like syndrome,
localized pain, arthralgia.
CNS: Headache, paresthesia, dizziness, insomnia.
CV: Arrhythmia.
GI: Dyspepsia, eructation, flatulence, nausea, vomiting, abdominal pain,

constipation, diarrhea, increased appetite.
Respiratory: Cough, rhinitis, sinusitis.

Skin: Pruritus, rash.
Special Senses: Earache, eye floaters, blurred vision, conjunctivitis, eye

irritation,
Urogenital: Decreased libido, polyuria, vaginitis.
83
Contraindications Hypersensitivity to fenofibrate or other fibric acid derivatives (e.g.,
clofibrate, benzofibrate); liver or severe kidney dysfunction; unexplained
liver function abnormality; primary biliary cirrhosis; preexisting
gallbladder disease; pregnancy (category C); lactation; thrombocytopenia.
Safety and efficacy in children are not established.
Responsibilities
 Lab tests: Periodically monitor lipid levels, liver functions, and
CBC with differential.
 Discontinue therapy after 2 mo if adequate lipid reduction is not
achieved with the maximum dose of 201 mg/d.
 Assess for muscle pain, tenderness, or weakness and, if present,
monitor CPK level. Withdraw drug with marked elevations of CPK
or if myopathy is suspected.
 Monitor patients on coumarin-type drugs closely for prolongation
of PT/INR.
 Contact physician immediately if any of the following develops:

Unexplained muscle pain, tenderness, or weakness, especially with
fever or malaise; yellowing of skin or eyes; nausea or loss of
appetite; skin rash or hives.
 Inform physician regarding concurrent use of cholestyramine, oral
anticoagulants, or cyclosporine.
84
ACETAMINOPHEN, PARACETAMOL
Generic Name ACETAMINOPHEN,
PARACETAMOL
Brand Name Abenol , A'Cenol,
Acephen, Anacin-3,
Anuphen, APAP,
Atasol , Campain ,
Datril Extra Strength,
Dolanex, Exdol ,
Halenol, Liquiprin,
Panadol, Pedric,
Robigesic , Rounox ,
Tapar, Tempra,
Tylenol, Valadol
Classification CENTRAL NERVOUS SYSTEM AGENT; NONNARCOTIC
ANALGESIC, ANTIPYRETIC
General Action Produces analgesia by unknown mechanism, perhaps by action on
peripheral nervous system. Reduces fever by direct action on hypothalamus
heat-regulating center with consequent peripheral vasodilation, sweating,
and dissipation of heat. Unlike aspirin, acetaminophen has little effect on
platelet aggregation, does not affect bleeding time, and generally produces
no gastric bleeding.
Dose and Route Mild to Moderate Pain, Fever
Adult: PO 325–650 mg q4–6h (max: 4 g/d) PR 650 mg q4–6h (max: 4 g/d)
Child: PO 10–15 mg/kg q4–6h PR 2–5 y, 120 mg q4–6h (max: 720 mg/d);
6–12 y, 325 mg q4–6h (max: 2.6 g/d)
Neonate: PO 10–15 mg/kg q6–8h
Indications or Fever reduction. Temporary relief of mild to moderate pain. Generally as
Purposes substitute for aspirin when the latter is not tolerated or is contraindicated.
Side effects Body as a Whole: Negligible with recommended dosage; rash. Acute
poisoning: Anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis,
chills, epigastric or abdominal pain, diarrhea; onset of hepatotoxicity—
elevation of serum transaminases (ALT, AST) and bilirubin; hypoglycemia,
hepatic coma, acute renal failure (rare). Chronic ingestion: Neutropenia,
pancytopenia, leukopenia, thrombocytopenic purpura, hepatotoxicity in
alcoholics, renal damage.
Contraindications Hypersensitivity to acetaminophen or phenacetin; use with alcohol.
Responsibilities
 Monitor for S&S of: hepatotoxicity, even with moderate
acetaminophen doses, especially in individuals with poor nutrition
or who have ingested alcohol over prolonged periods; poisoning,
85
usually from accidental ingestion or suicide attempts; potential
abuse from psychological dependence (withdrawal has been
associated with restless and excited responses).
 Do not take other medications (e.g., cold preparations) containing

acetaminophen without medical advice; overdosing and chronic use
can cause liver damage and other toxic effects.
 Do not self-medicate adults for pain more than 10 d (5 d in children)
without consulting a physician.
 Do not use this medication without medical direction for: fever
persisting longer than 3 d, fever over 39.5° C (103° F), or recurrent
fever.
 Do not give children more than 5 doses in 24 h unless prescribed by
physician.
 Do not breast feed while taking this drug without consulting
physician.
86
ATORVASTATIN CALCIUM
Generic Name ATORVASTATIN
CALCIUM
Brand Name Lipitor
Classification CARDIOVASCULAR AGENT; ANTILIPEMIC AGENT; HMG-COA;

REDUCTASE INHIBITOR (STATIN)
General Action Atorvastatin is an inhibitor of reductase 3-hydroxy-3-methyl-glutaryl
coenzyme A (HMG-CoA), which is essential to hepatic production of
cholesterol. Lipitor increases the number of hepatic low-density-lipid
(LDL) receptors, thus increasing LDL uptake and catabolism of LDL.
Dose and Route Hypercholesterolemia
Adult: PO Start with 10–40 mg q.d., may increase up to 80 mg/d
Child/Adolescent: PO 10–17 y: Start with 10 mg q.d., may increase up to 20
mg/d
Indications or Adjunct to diet for the reduction of LDL cholesterol and triglycerides in
Purposes patients with primary hypercholesterolemia and mixed dyslipidemia.
Side effects Body as a Whole: Back pain, asthenia, hypersensitivity reaction, myalgia,
rhabdomyolysis. CNS: Headache. GI: Abdominal pain, constipation,
diarrhea, dyspepsia, flatulence, increased liver function tests. Respiratory:
Sinusitis, pharyngitis. Skin: Rash.
Contraindications Hypersensitivity to atorvastatin, myopathy, active liver disease,
unexplained persistent transaminase elevations, pregnancy (category X),
lactation.
Responsibilities
 Monitor for therapeutic effectiveness which is indicated by
reduction in the level of LDL-C.
87
 Lab tests: Monitor lipid levels within 2–4 wk after initiation of
therapy or upon change in dosage; monitor liver functions at 6 and
12 wk after initiation or elevation of dose, and periodically
thereafter.
 Assess for muscle pain, tenderness, or weakness; and, if present,
monitor CPK level (discontinue drug with marked elevations of
CPK or if myopathy is suspected).
 Monitor carefully for digoxin toxicity with concurrent digoxin use.
 Report promptly any of the following: Unexplained muscle pain,

tenderness, or weakness, especially with fever or malaise; yellowing
of skin or eyes; stomach pain with nausea, vomiting, or loss of
appetite; skin rash or hives.
 Do not take drug during pregnancy because it may cause birth
defects. Immediately inform physician of a suspected or known
pregnancy.
 Inform physician regarding concurrent use of any of the following
drugs: erythromycin, niacin, antifungals, or birth control pills.
 Minimize alcohol intake while taking this drug.
88
AZITHROMYCIN
Generic Name AZITHROMYCIN
Brand Name Zithromax, Zmax
Classification ANTIINFECTIVE; MACROLIDE ANTIBIOTIC

General Action A macrolide antibiotic that reversibly binds to the 50S ribosomal subunit of
susceptible organisms and consequently inhibits protein synthesis.
Dose and Route Bacterial Infections
Adult: PO 500 mg on day 1, then 250 mg q24h for 4 more d IV 500 mg
q.d. for at least 2 d, administer 1 mg/mL over 3 h or 2 mg/mL over 1 h
Child: PO 6 mo, 10 mg/kg on day 1, then 5 mg/kg for 4 more d (max:
250 mg/d)
Acute Bacterial Sinusitis

Adult: PO 500 mg once daily x 3 d. Zmax: single one-time dose of 2 g.
Child: PO 6 mo, 10 mg/kg once daily x 3 d
Otitis Media
Child: PO >6 mo, 30 mg/kg as a single dose or 10 mg/kg once daily (not to
exceed 500 mg/d) for 3 d or 10 mg/kg as a single dose on day 1 followed
by 5 mg/kg/d on days 2–5
Gonorrhea
Adult: PO 2 g as a single dose
Chancroid
Adult: PO 1 g as a single dose
Child: PO 20 mg/kg as single dose (max: 1 g)
Indications or Pneumonia, lower respiratory tract infections, pharyngitis/tonsillitis,
Purposes gonorrhea, nongonococcal urethritis, skin and skin structure infections due
89
to susceptible organisms, otitis media, Mycobacterium avium–
intracellulare complex infections, acute bacterial sinusitis. Zmax: acute
bacterial sinusitis and community acquired pneumonia.
Side effects CNS: Headache, dizziness.
GI: Nausea, vomiting, diarrhea, abdominal pain; hepatotoxicity, mild
elevations in liver function tests.
Contraindications Hypersensitivity to azithromycin, erythromycin, or any of the macrolide
antibiotics.
Responsibilities
 Monitor for and report loose stools or diarrhea, since
pseudomembranous colitis (see Appendix F) must be ruled out.
 Monitor PT and INR closely with concurrent warfarin use.
 Direct sunlight (UV) exposure should be minimized during therapy

with drug.
 Take aluminum or magnesium antacids 2 h before or after drug.
 Report onset of loose stools or diarrhea.
physician.
ACETYLCYSTEINE
90
Generic Name ACETYLCYSTEINE
Brand Name Airbron, Mucomyst,
Mucosol, N-
Acetylcysteine,
Acetadote, Acys-5
Classification SKIN AND MUCOUS MEMBRANE AGENT; MUCOLYTIC;

ANTIDOTE
General Action Acetylcysteine probably acts by disrupting disulfide linkages of
mucoproteins in purulent and nonpurulent secretions.
Dose and Route Mucolytic
Adult: Inhalation 1–10 mL of 20% solution q4–6h or 2–20 mL of 10%
solution q4–6h Direct Instillation 1–2 mL of 10–20% solution q1–4h
Child: Inhalation 3–5 mL of 20% solution or 6–10 mL of 10% solution 3–
4 times/d
Infant: Inhalation 1–2 mL 20% solution or 2–4 mL of 10% solution 3–4
times/d
Acetaminophen Toxicity
Adult/Child: PO 140 mg/kg followed by 70 mg/kg q4h for 17 doses (use a
5% solution)
Adult/Adolescent: IV 150 mg/kg infused over 15 min, followed by 50
mg/kg over 4 h, then 100 mg/kg over 16 h; OR 140 mg/kg infused over 1 h,
then, 4 h after the loading dose, give 70 mg/kg q4h x 12 doses
Indications or Adjuvant therapy in patients with abnormal, viscid, or inspissated mucous

Purposes secretions in acute and chronic bronchopulmonary diseases, and in
pulmonary complications of cystic fibrosis and surgery, tracheostomy, and
atelectasis. Also used in diagnostic bronchial studies and as an antidote for
acute acetaminophen poisoning.
Side effects CNS: Dizziness, drowsiness.
GI: Nausea, vomiting, stomatitis, hepatotoxicity (urticaria).
91
Respiratory: Bronchospasm, rhinorrhea, burning sensation in upper
respiratory passages, epistaxis.
Contraindications Hypersensitivity to acetylcysteine; patients at risk of gastric hemorrhage.
Responsibilities
 During IV infusion, carefully monitor for fluid overload and signs
of hyponatremia (i.e., changes in mental status).
 Monitor for S&S of aspiration of excess secretions, and for
bronchospasm (unpredictable); withhold drug and notify physician
immediately if either occurs.
 Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry
as indicated.
 Have suction apparatus immediately available. Increased volume of
respiratory tract fluid may be liberated; suction or endotracheal
aspiration may be necessary to establish and maintain an open
airway. Older adults and debilitated patients are particularly at risk.
 Nausea and vomiting may occur, particularly when face mask is
used, due to unpleasant odor of drug and excess volume of liquefied
bronchial secretions.
 Report difficulty with clearing the airway or any other respiratory

distress.
 Report nausea, as an antiemetic may be indicated.
 Note: Unpleasant odor of inhaled drug becomes less noticeable with
continued use.
physician.
92
FUROSEMIDE
Generic Name FUROSEMIDE
Brand Name Fumide, Furomide,

Lasix, Luramide
Classification ELECTROLYTIC AND WATER BALANCE AGENT; LOOP

DIURETIC
General Action Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with
pharmacologic effects and uses almost identical to those of ethacrynic acid.
Exact mode of action not clearly defined; decreases renal vascular
resistance and may increase renal blood flow.
Dose and Route Edema
Adult: PO 20–80 mg in 1 or more divided doses up to 600 mg/d if needed
IV/IM 20–40 mg in 1 or more divided doses up to 600 mg/d
Child: PO 2 mg/kg, may be increased by 1–2 mg/kg q6–8h (max: 6
mg/kg/dose) IV/IM 1 mg/kg, may be increased by 1 mg/kg q2h if needed
(max: mg/kg/dose)
Neonate: PO 1–4 mg/kg q12–24h IV/IM 1–2 mg/kg q12–24h
Hypertension
Adult: PO 10–40 mg b.i.d. (max: 480 mg/d)
Indications or Treatment of edema associated with CHF, cirrhosis of liver, and kidney
Purposes disease, including nephrotic syndrome. May be used for management of
hypertension, alone or in combination with other antihypertensive agents,
and for treatment of hypercalcemia. Has been used concomitantly with
mannitol for treatment of severe cerebral edema, particularly in meningitis.
Side effects CV: Postural hypotension, dizziness with excessive diuresis, acute
hypotensive episodes, circulatory collapse.
Metabolic: Hypovolemia, dehydration,
hyponatremia hypokalemia, hypochloremia metabolic alkalosis,
93
hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria,
elevated BUN, hyperuricemia.
GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea,
constipation, abdominal cramping, acute pancreatitis, jaundice.
Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary
frequency.
Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic
anemia, agranulocytosis (rare).
Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss
(rarely permanent), blurred vision.
Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity,
porphyria cutanea tarde, necrotizing angiitis (vasculitis).
Body as a Whole: Increased perspiration; paresthesias; activation of SLE,
muscle spasms, weakness; thrombophlebitis, pain at IM injection site.
Contraindications History of hypersensitivity to furosemide or sulfonamides; increasing
oliguria, anuria, fluid and electrolyte depletion states; hepatic coma;
pregnancy (category C), lactation.
Responsibilities
 Observe patients receiving parenteral drug carefully; closely
monitor BP and vital signs. Sudden death from cardiac arrest has
been reported.
 Monitor for S&S of hypokalemia (see Appendix F).
 Monitor BP during periods of diuresis and through period of dosage
adjustment.
 Observe older adults closely during period of brisk diuresis. Sudden
alteration in fluid and electrolyte balance may precipitate
significant adverse reactions. Report symptoms to physician.
 Lab tests: Obtain frequent blood count, serum and urine
electrolytes, CO2, BUN, blood sugar, and uric acid values during
first few months of therapy and periodically thereafter.
 Monitor I&O ratio and pattern. Report decrease or unusual increase
in output. Excessive diuresis can result in dehydration and
hypovolemia, circulatory collapse, and hypotension. Weigh patient
daily under standard conditions.
 Monitor urine and blood glucose & HbA1C closely in diabetics and
patients with decompensated hepatic cirrhosis. Drug may cause
hyperglycemia.
 Note: Excessive dehydration is most likely to occur in older adults,
those with chronic cardiac disease on prolonged salt restriction, or
those receiving sympatholytic agents.
 Consult physician regarding allowable salt and fluid intake.
94
 Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches,
dried dates) to reduce or prevent potassium depletion.
 Learn S&S of hypokalemia (see Appendix F). Report muscle
cramps or weakness to physician.
 Make position changes slowly because high doses of
antihypertensive drugs taken concurrently may produce episodes of
dizziness or imbalance.
 Avoid replacing fluid losses with large amounts of water.
 Avoid prolonged exposure to direct sun.
95
BERODUAL
Generic Name Ipratropium bromid,
fenoterol hydrobromide
Brand Name Berodual
Classification Pharmacotherapeutic: Anticho- linergic. Clinical: Bronchodilator.

Indication a bronchodilator for the prevention and treatment of symptoms in chronic
obstructive airway disorders with reversible airflow limitation such as
bronchial asthma and especially chronic bronchitis with or without
emphysema. Concomitant anti-inflammatory therapy should be
considered for patients with bronchial asthma and steroid responsive
chronic obstructive pulmonary disease (COPD).
Contraindication It is contraindicated in patients with known hypersensitivity to fenoterol
hydrobromide or atropine-like substances or to any of the excipients of the
product. It is also contraindicated in patients with hypertrophic obstructive
cardiomyopathy and tachyarrhythmia.
Dosage 1 mL contains 261 mcg ipratropium bromide + 500 mcg fenoterol
hydrobromide); (20 drops = 1 mL)
Availability Solution for Nebulization: 0.02% (500 mcg).
Route Nebulization
• May be administered with or without dilution in 0.9% NaCl. • Stable
for 1 hr when mixed with albuterol. • Give over 5–15 min.
Mechanism of Blocks action of acetylcholine at parasym- pathetic sites in bronchial

smooth muscle. Therapeutic Effect: Causes bronchodilation, inhibits
Action
nasal secretions.
Drug Interaction Enhanced bronchodilatory effect w/ other β-adrenergics, anticholinergics

& xanthine derivatives (eg, theophylline). Reduced bronchodilation w/ β-
blockers. Induced hypokalaemia w/ xanthine derivatives, corticosteroids
& diuretics. Increased susceptibility to arrhythmias w/ digoxin. Enhanced
action w/ MAOIs, TCAs. Increased susceptibility on CV effects w/
96
halogenated hydrocarbon anaesth inhalation eg, halothane,
trichloroethylene & enflurane.
Side Effects Frequent: Inhalation (6%–3%): Cough, dry mouth, headache, nausea.
Nasal: Dry nose/mouth, headache, nasal irritation. Occasional: Inhalation
(2%): Dizzi- ness, transient increased bronchospasm. Rare (less than 1%):
Inhalation: Hypo- tension, insomnia, metallic/unpleasant taste,
palpitations, urinary retention. Na- sal: Diarrhea, constipation, dry throat,
abdominal pain, nasal congestion.
Adverse Effects Worsening of angle-closure glaucoma, acute eye pain, hypotension occur
rarely.
Nursing  Protect solution for inhalation from light. Store unused vials in foil
pouch.
Responsibilities
 Use nebulizer mouthpiece instead of face mask to avoid blurred
vision or aggravation of narrow-angle glaucoma.
 Can mix albuterol in nebulizer for up to 1 hr.
 Ensure adequate hydration, control environmental temperature to
prevent hyperpyrexia.
 Have patient void before taking medication to avoid urinary
retention.
 Teach patient proper use of inhaler.
97
ISOSORBIDE MONONITRATE
Generic Name ISOSORBIDE
MONONITRATE
Brand Name Ismo, Imdur,
Monoket
Classification CARDIOVASCULAR AGENT; NITRATE VASODILATOR

General Action Isosorbide mononitrate is a long-acting metabolite of the coronary
vasodilator isosorbide dinitrate. It decreases preload as measured by
pulmonary capillary wedge pressure (PCWP), and left ventricular end
volume and diastolic pressure (LVEDV), with a consequent reduction in
myocardial oxygen consumption.
Dose and Route Prevention of Angina
Adult: PO Regular release (ISMO, Monoket) 20 mg b.i.d. 7 h apart;
Sustained release (Imdur) 30–60 mg every morning, may increase up to
120 mg once daily after several days if needed (max: dose 240 mg)
Indications or Prevention of angina. Not indicated for acute attacks.
Purposes
Side effects CNS: Headache, agitation, anxiety, confusion, loss of coordination,
hypoesthesia, hypokinesia, insomnia or somnolence, nervousness, migraine
headache, paresthesia, vertigo, ptosis, tremor.
CV: Aggravation of angina, abnormal heart sounds, murmurs, MI,
transient hypotension, palpitations.
Hematologic: Hypochromic anemia, purpura, thrombocytopenia,
methemoglobinemia (high doses).
GI: Nausea, vomiting, dry mouth, abdominal pain, constipation, diarrhea,
dyspepsia, flatulence, tenesmus, gastric ulcer, hemorrhoids, gastritis,
glossitis.
Metabolic: Hyperuricemia, hypokalemia.
GU: Renal calculus, UTI, atrophic vaginitis, dysuria, polyuria, urinary
frequency, decreased libido, impotence.
Respiratory: Bronchitis, pneumonia, upper respiratory tract infection,
nasal congestion, bronchospasm, coughing, dyspnea, rales, rhinitis.
Skin: Rash, pruritus, hot flashes, acne, abnormal texture.
Special Senses: Diplopia, blurred vision, photophobia, conjunctivitis.
98
Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma,
postural hypotension, head trauma, cerebral hemorrhage (increases
intracranial pressure). Safe use during pregnancy [(category C) and
(category B) for sustained form] or lactation is not established.
Responsibilities
 Monitor cardiac status, frequency and severity of angina, and BP.
 Assess for and report possible S&S of toxicity, including orthostatic
hypotension, syncope, dizziness, palpitations, light-headedness,
severe headache, blurred vision, and difficulty breathing.
 Lab tests: Monitor serum electrolytes periodically.
 Do not crush or chew sustained release tablets. May break tablets in

two and take with adequate fluid (4–8 oz).
 Do not withdraw drug abruptly; doing so may precipitate acute
angina.
 Maintain correct dosing interval with twice daily dosing.
 Note: Geriatric patients are more susceptible to the possibility of
developing postural hypotension.
 Avoid alcohol ingestion and aspirin unless specifically permitted by
physician.
physician.
99
ISOSORBIDE DINITRATE
Generic Name ISOSORBIDE
DINITRATE
Brand Name Coronex ,
Dilatrate-SR, Iso-
Bid, Isordil,
Isotrate,
Novosorbide ,
Sorbitrate,
Sorbitrate SA
Classification CARDIOVASCULAR AGENT; NITRATE VASODILATOR

General Action Organic nitrate with pharmacologic actions similar to those of
nitroglycerin. Relaxes vascular smooth muscle with resulting vasodilation.
Dilation of peripheral blood vessels tends to cause peripheral pooling of
blood, decreased venous return to heart, and decreased left ventricular end-
diastolic pressure, with consequent reduction in myocardial oxygen
consumption.
Dose and Route Angina Prophylaxis
Adult: PO Regular tablets 2.5–30 mg q.i.d. a.c. and h.s.; Sublingual tablet
2.5–10 mg q4–6h; Chewable tablet 5–30 mg chewed q2–3h; Sustained
release tablets 40 mg q6–12h
Acute Anginal Attack

Adult: PO Sublingual tablet 2.5–10 mg q2–3h prn; Chewable tablet 5–30
mg chewed prn for relief
Indications or Relief of acute anginal attacks and for management of long-term angina
Purposes pectoris.
Side effects Body as a Whole: Hypersensitivity reaction, paradoxical increase in
anginal pain, methemoglobinemia (overdose).
CNS: Headache, dizziness, weakness, lightheadedness, restlessness.
CV: Palpitation, postural hypotension, tachycardia.
GI: Nausea, vomiting. Skin: Flushing, pallor, perspiration, rash, exfoliative
dermatitis.
100
Contraindications Hypersensitivity to nitrates or nitrites; severe anemia; head trauma;
increased intracranial pressure. Safe use during pregnancy (category C) or
lactation is not established
Responsibilities
 Monitor effectiveness of drug in relieving angina.
 Note: Headaches tend to decrease in intensity and frequency with
continued therapy but may require administration of analgesic and
reduction in dosage.
 Note: Chronic administration of large doses may produce tolerance
and thus decrease effectiveness of nitrate preparations.
 Make position changes slowly, particularly from recumbent to

upright posture, and dangle feet and ankles before walking.
 Lie down at the first indication of light-headedness or faintness.
 Keep a record of anginal attacks and the number of sublingual
tablets required to provide relief.
 Do not drink alcohol because it may increase possibility of light-
headedness and faintness.
physician.
101
CLOPIDOGREL BISULFATE
Generic Name CLOPIDOGREL
BISULFATE
Brand Name Plavix
Classification BLOOD FORMERS, COAGULATORS, AND ANTICOAGULANTS;

ANTIPLATELET AGENT
General Action Inhibits platelet aggregation by selectively preventing the binding of adenosine
diphosphate to its platelet receptor. It is an analog of ticlopidine. The drug's
effect on the adenosine diphosphate receptor of a platelet is irreversible.
Dose and Route Secondary Prevention
Adult: PO 75 mg q.d.
Indications or Secondary prevention of MI, stroke, and vascular death in patients with recent
Purposes MI, stroke, unstable angina or established peripheral arterial disease.
Side effects Body as a Whole: Flu-like syndrome, fatigue, pain, arthralgia, back pain.
CV: Chest pain, edema, hypertension, thrombocytic purpura.
GI: Abdominal pain, dyspepsia, diarrhea, nausea, hypercholesterolemia.
Hematologic: Thrombotic thrombocytopenic purpura, epistaxis.
CNS: Headache, dizziness, depression.
Respiratory: URI, dyspnea, rhinitis, bronchitis, cough.
Skin: Rash, pruritus.
Contraindications Hypersensitivity to clopidogrel; intracranial hemorrhage, peptic ulcer, or any
other active pathologic bleeding; pregnancy (category B). Discontinue
clopidogrel 7 d before surgery and during lactation. Safety and efficacy not
established in children.
Responsibilities
 Carefully monitor for and immediately report S&S of GI bleeding,
especially when coadministered with NSAIDs, aspirin, heparin, or
warfarin.
102
 Lab tests: Periodic platelet count and lipid profile.
 Evaluate patients with unexplained fever or infection for myelotoxicity.
 Report promptly any unusual bleeding (e.g., black, tarry stools).

 Avoid chronic aspirin or NSAID use unless approved by physician.
103
ASPIRIN
Generic Name ASPIRIN
(ACETYLSALICYLIC
ACID)
Brand Name Alka-Seltzer, A.S.A.,
Aspergum, Astrin ,
Bayer, Bayer
Children's, Cosprin,
Easprin, Ecotrin,
Empirin, Entrophen ,
Halfprin, Measurin,
Novasen , St. Joseph
Children's, Supasa ,
Triaphen-10 , ZORprin
Classification CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC,

SALICYLATE; ANTIPYRETIC; ANTIPLATELET
General Action Major actions appear to be associated primarily with inhibiting the
formation of prostaglandins involved in the production of inflammation,
pain, and fever. Antiinflammatory action: Inhibits prostaglandin synthesis.
As an antiinflammatory agent, aspirin appears to be involved in enhancing
antigen removal and in reducing the spread of inflammation in ground
substances. These antiinflammatory actions also contribute to analgesic
effects. Analgesic action: Principally peripheral with limited action in the
CNS, possibly on the hypothalamus; results in relief of mild to moderate
pain. Antipyretic action: In addition to inhibiting prostaglandin synthesis,
aspirin lowers body temperature in fever by indirectly causing centrally
mediated peripheral vasodilation and sweating. Antiplatelet
action: Aspirin (but not other salicylates) powerfully inhibits platelet
aggregation. High serum salicylate concentrations can impair hepatic
synthesis of blood coagulation factors VII, IX, and X, possibly by inhibiting
action of vitamin K.
Dose and Route Mild to Moderate Pain, Fever
Adult: PO/PR 350–650 mg q4h (max: 4 g/d)
Child: PO/PR 10–15 mg/kg in 4–6 h (max: 3.6 g/d)
Arthritic Conditions
Adult: PO 3.6–5.4 g/d in 4–6 divided doses
Child: PO 80–100 mg/kg/d in 4–6 divided doses; max 130 mg/kg/d
104
Thromboembolic Disorders
Adult: PO 81–325 mg qd
TIA Prophylaxis
Adult: PO 650 mg b.i.d.
MI Prophylaxis
Adult: PO 80–325 mg/d
Indications or To relieve pain of low to moderate intensity. Also for various inflammatory
Purposes conditions, such as acute rheumatic fever, Systemic Lupus, rheumatoid
arthritis, osteoarthritis, bursitis, and calcific tendonitis, and to reduce fever
in selected febrile conditions. Used to reduce recurrence of TIA due to
fibrin platelet emboli and risk of stroke in men; to prevent recurrence of
MI; as prophylaxis against MI in men with unstable angina.
Side effects Body as a Whole: Hypersensitivity (urticaria, bronchospasm,
anaphylactic shock (laryngeal edema).
CNS: Dizziness, confusion, drowsiness.
Special Senses: Tinnitus, hearing loss.
GI: Nausea, vomiting, diarrhea, anorexia, heartburn, stomach
pains, ulceration, occult bleeding, GI bleeding.
Hematologic: Thrombocytopenia, hemolytic anemia, prolonged bleeding
time.
Skin: Petechiae, easy bruising, rash.
Urogenital: Impaired renal function.
Other: Prolonged pregnancy and labor with increased bleeding.
Contraindications History of hypersensitivity to salicylates including methyl salicylate (oil of
wintergreen); sensitivity to other NSAIDs; patients with "aspirin triad"
(aspirin sensitivity, nasal polyps, asthma); chronic rhinitis; chronic
urticaria; history of GI ulceration, bleeding, or other problems;
hypoprothrombinemia, vitamin K deficiency, hemophilia, or other
bleeding disorders; CHF. Do not use aspirin during pregnancy (category D),
especially in third trimester; lactation; or in prematures, neonates, or
children under 2 y, except under advice and supervision of physician. Do
not use in children or teenagers with chickenpox or influenza-like illnesses
because of possible association with Reye's syndrome.
Responsibilities
 Monitor for loss of tolerance to aspirin. The reaction is
nonimmunologic; symptoms usually occur 15 min to 3 h after
ingestion: profuse rhinorrhea, erythema, nausea, vomiting, intestinal
cramps, diarrhea.
105
 Lab tests: frequent PT and IRN with concurrent anticoagulant
therapy; more frequent fasting blood glucose levels with diabetes.
 Monitor the diabetic child carefully for need to adjust insulin dose.
Children on high doses of aspirin are particularly prone to
hypoglycemia (see Appendix F).
 Monitor for salicylate toxicity. In adults, a sensation of fullness in
the ears, tinnitus, and decreased or muffled hearing are the most
frequent symptoms associated with chronic salicylate overdosage.
 Monitor children closely because salicylate toxicity is enhanced by
the dehydration that frequently accompanies fever or illness.
Children tend to manifest salicylate toxicity by hyperventilation,
agitation, mental confusion, or other behavioral changes,
drowsiness, lethargy, sweating, and constipation.
 Note: Potential for toxicity is high in older adults and patients with
asthma, nasal polyps, perennial vasomotor rhinitis, hay fever, or
chronic urticaria.
 Do not give aspirin to children or teenagers with symptoms of

varicella (chickenpox) or influenza-like illnesses because of
association of aspirin usage with Reye's syndrome.
 Use enteric-coated tablets, extended release tablets, buffered
aspirin, or aspirin administered with an antacid to reduce GI
disturbances.
 Take aspirin 1–2 d before menses when prescribed for
dysmenorrhea. When experiencing heavy menstrual blood loss, take
another analgesic, such as acetaminophen, instead of aspirin.
 Discontinue aspirin therapy about 1 wk before surgery to reduce
risk of bleeding. Do not use aspirin-containing gum or gargles or
chew aspirin products for at least 1 wk following oral surgery.
 Note: Chronic use of high-dose aspirin during the last 3 mo of
pregnancy can prolong pregnancy and labor, increase maternal
bleeding before and after-delivery, and cause weight increase and
hemorrhage in the neonate.
 Discontinue aspirin use with onset of ringing or buzzing in the ears,
impaired hearing, dizziness, GI discomfort or bleeding, and report
to physician.
 Do not use aspirin for self-medication of pain (adults) beyond 5 d
without consulting a physician. Do not use aspirin longer than 3 d
for fever (adults and children), never for fever over 38.9° C (102° F)
in older adults or 39.5° C (103° F) in children and adults under 60
yrs or for recurrent fever without medical direction.
 Consult physician before using aspirin for any fever accompanied
by rash, severe headache, stiff neck, marked irritability, or
confusion (all possible symptoms of meningitis).
106
 Avoid alcohol when taking large doses of aspirin.
 Observe and report signs of bleeding (e.g., petechiae, ecchymoses,
bleeding gums, bloody or black stools, cloudy or bloody urine).
 Maintain adequate fluid intake when taking repeated doses of
aspirin.
 Avoid other medications containing aspirin unless directed by
physician, because of danger of overdosing (there are more than 500
OTC aspirin-containing compounds).
107
SODIUM BICARBONATE NA(HCO3)
Generic Name SODIUM
BICARBONATE
NA(HCO3)
Brand Name Sodium Bicarbonate
Classification GASTROINTESTINAL AGENT; ANTACID; FLUID AND

ELECTROLYTE BALANCE AGENT
General Action Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to
form sodium chloride, carbon dioxide, and water. After absorption of
sodium bicarbonate, plasma alkali reserve is increased and excess sodium
and bicarbonate ions are excreted in urine, thus rendering urine less acid.
Not suitable for treatment of peptic ulcer because it is short-acting, high in
sodium, and may cause gastric distention, systemic alkalosis, and possibly
acid-rebound.
Dose and Route Antacid
Adult: PO 0.3–2 g 1–4 times/d or ½ tsp of powder in glass of water
Urinary Alkalinizer
Adult: PO 4 g initially, then 1–2 g q4h
Child: PO 84–840 mg/kg/d in divided doses
Cardiac Arrest
Adult: IV 1 mEq/kg of a 7.5% or 8.4% solution initially, then 0.5 mEq/kg
q10 min depending on arterial blood gas determinations (8.4% solutions
contain 50 mEq/50 mL), give over 1–2 min
108
Child: IV 0.5–1 mEq/kg of a 4.2% solution q10 min depending on arterial
blood gas determinations, give over 1–2 min
Metabolic Acidosis
Adult: IV 2–5 mEq/kg by IV infusion over 4–8 h
Infant: IV 2–3 mEq/kg/d of a 4.2% solution over 4–8 h
Indications or Systemic alkalinizer to correct metabolic acidosis (as occurs in diabetes
Purposes mellitus, shock, cardiac arrest, or vascular collapse), to minimize uric acid
crystallization associated with uricosuric agents, to increase the solubility
of sulfonamides, and to enhance renal excretion of barbiturate and
salicylate overdosage. Commonly used as home remedy for relief of
occasional heartburn, indigestion, or sour stomach. Used topically as paste,
bath, or soak to relieve itching and minor skin irritations such as sunburn,
insect bites, prickly heat, poison ivy, sumac, or oak. Sterile solutions are
used to buffer acidic parenteral solutions to prevent acidosis. Also as a
buffering agent in many commercial products (e.g., mouthwashes, douches,
enemas, ophthalmic solutions).
Side effects GI: Belching, gastric distention, flatulence.
Metabolic: Metabolic alkalosis; electrolyte imbalance: sodium overload
(pulmonary edema), hypocalcemia (tetany), hypokalemia, milk-alkali
syndrome, dehydration.
Other: Rapid IV in neonates (Hypernatremia, reduction in CSF
pressure, intracranial hemorrhage).
Skin: Severe tissue damage following extravasation of IV solution.
Urogenital: Renal calculi or crystals, impaired kidney function.
Contraindications Prolonged therapy with sodium bicarbonate; patients losing chloride (as
from vomiting, GI suction, diuresis); heart disease, hypertension; renal
insufficiency; peptic ulcer; pregnancy (category C).
Responsibilities
 Be aware that long-term use of oral preparation with milk or
calcium can cause milk-alkali syndrome: Anorexia, nausea,
vomiting, headache, mental confusion, hypercalcemia,
hypophosphatemia, soft tissue calcification, renal and ureteral
calculi, renal insufficiency, metabolic alkalosis.
 Lab tests: Urinary alkalinization: Monitor urinary pH as a guide to
dosage (pH testing with nitrazine paper may be done at intervals
throughout the day and dosage adjustments made accordingly).
 Lab tests: Metabolic acidosis: Monitor patient closely by
observations of clinical condition; measurements of acid-base status
(blood pH, Po2, Pco2, HCO3 –, and other electrolytes, are usually
made several times daily during acute period). Observe for signs of
alkalosis (over treatment) (see Appendix F).
109
 Observe for and report S&S of improvement or reversal of
metabolic acidosis (see Appendix F).
 Do not use sodium bicarbonate as antacid. A nonabsorbable OTC

alternative for repeated use is safer.
 Do not take antacids longer than 2 wk except under advice and
supervision of a physician. Self-medication with routine doses of
sodium bicarbonate or soda mints may cause sodium retention and
alkalosis, especially when kidney function is impaired.
 Be aware that commonly used OTC antacid products contain
sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon.
physician.
110
XVI. NURSING THEORIES
Florence Nightingale’s Environmental Theory
“Nursing is the art of utilizing one’s environment for his or her own recovery”
According to Florence Nightingale’s Environmental theory “Nursing is the art of utilizing
one’s environment for his or her own recovery.”. Nightingale’s theory focuses on the role that the
environment plays on the patient’s overall health. In this theory it is said that the nurse is in control
of the environment, physically and administratively. It is the responsibility of the nurse to control
the environment so that the patient is protected from physical and psychological harm and that the
patient’s environment will be a tool that would aid in the healing process of the patient to achieve
optimum health.
Environment is defined as the external conditions and influences affecting the life and
development of an organism. The environment is also capable of preventing, suppressing or
contributing to disease, accidents, or deaths (Murray and Zentner, 1975). Thus, the nurse should
111
take into account the situation of the environment of the patient because it can contribute to the
healing of the patient, but it could also contribute to the worsening of the condition of the patient.
The center of Florence Nightingale’s theory is the concept of environmental sanitation.
With environmental sanitation you would have in turn a healthy environment which is
characterized by pure air, pure water, efficient drainage, cleanliness and light.
The relation of Florence’s Nightingale’s Environmental Theory to the patient is that by
altering the environment of the patient as much as situation allows the group was able to prevent,
suppress or contribute to the disease and prevent accidents and even death.
One example on how the group altered the environment of the patient is by improving the
state of the area of the patient which is her bed. By tidying up the area of the patient, the group
was able to reduce the risk of trauma to the patient and promote comfort that in turn benefits the
health.
Cleanliness was a concern for our patient because since he has an infection it is a priority
to prevent progression of the disease and prevent any further complications. The patient’s current
condition has a great interaction with the environment because an unhealthy environment may lead
to further infection since the patient is very susceptible to further infection. Since the patient has
problems with respiration, it is very important to keep the quality of air around the patient. Even
if the patient is using supplemental oxygen it is still very important to keep the area well ventilated
and give an opportunity for fresh air to flow inside the room of the patient. A healthy environment
is essential to healing. Nutritious food, beds and appropriate bed linen and individual's personal
hygiene are essential with a clean environment the number of cases of infection decrease.
112
Imogene King’s Goal Attainment Theory
“Nursing is an observable behavior found in the health care systems in society that aims to help
individuals maintain their health, so they can function in their roles”
Imogene King’s Goal Attainment theory wants to incorporate the concept of the nurse and the
patient mutually in communicating information, establishing goals and taking action to attain a
certain goal formulated by the nurse for the achievement of optimum health of the patient.
In Imogene King’s Goal Attainment Theory, this theory described the nursing profession as a
helping profession that assists individuals and groups in society to attain, maintain and restore
health. The central focus of Imogene King’s framework is man as a dynamic human being those
perceptions of objects, persons and events influence his behavior, social interaction, and health
(King, 1971).
The systems in this theory include personal systems, interpersonal systems and social
systems. Personal systems are composed of the patient’s body image, growth and development,
113
perception, self, space and time. These concepts relate to the individual him/herself as an
individual person, but when the person interacts to another person or more than one person it would
then form an interpersonal system. Interpersonal system then includes the concepts of
communication, interaction, role, stress and transaction those mentioned concepts emphasizes the
interaction between two or more persons. The comprehensive interacting system is then made up
of groups that would then in turn make up a society. This would then result to the social system.
The social system is then composed of concepts of authority, decision-making, organization
power, and status. These concepts would then provide much needed knowledge for nurses so that
they will be able to function competently in larger systems.
Imogene King’s Goal Attainment theory relates to our patient because the group had
formulated a set of goals for the patient that she should be able to attain to reach her optimum
health. These goals can be found in the nursing care plans which the group strategically planned
and formulated specifically for the patient for the attainment of his optimum health.
For the patient, one of the goals the group established was to prevent infection and to
prevent any further progression of his diagnosis and to achieve his optimum level of health. For
interpersonal systems, the patient was able to interact with the group, he was very verbal about her
history and the current situation he is going through and he was very prompt and honest in
answering the group’s questions. He interacted well even though he gets tired easily. The group
assessed the patient and discussed the problems and the group was able to gain the cooperation of
the patient in doing the planned interventions the group provided to promote wellness, obtain the
optimum health of the patient and successfully attain our goals. The patient has a good relationship
114
with his wife which played a big role in his recovery and hospital stay because his wife was the
one who took care of him and visited her while he was confined in the hospital.
For personal systems, the patient was previously a chain smoker but has now decided to
actively try and stop smoking once he gets discharged from the hospital. The patient realized a lot
after being confined in the hospital and is now ready to be more aware of his body.
Lastly for the social system, his visitors and watchers in the ward helped him a lot for he
does not get bored because of the company and support they provided each other. The patient may
also communicate with his family and friends via text messaging through his cellular phone where
his family and friends send their best wishes for a fast recovery. It was a good diversional activity
to have people around to communicate with. The patient also worked well with the healthcare team
in the hospital where he complies with the health regimen formulated for him so that he can achieve
his optimum level of health. The health care team who provided him with care for he follows the
orders given to him by the doctors, the group and nurses in the hospital. The patient also interacts
with the people outside the healthcare team that work in the hospital for example he keeps his area
clean to help the janitors do their job properly.
Overall, the group together with the patient identified problems, formulated goals, did
interventions and evaluated for the result. With the gained cooperation from the patient it made it
easy to assess and identify problems. instructions and health teachings that lead us to successfully
attain the goals the group has formulated.
115
Virginia Henderson’s Need Theory
“I say that the nurse does for others what they would do for themselves if they had the strength,
the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him
or her as soon as possible.”
Virginia Henderson strongly believed in “getting inside the skin” of her patients in order
to know what the patient needs. The nurse should be the substitute for the patient, helper to the
patient and the partner with the patient.
Virginia Henderson’s theory is vital to clinical nurses today especially in the practice of
bedside nursing where the nurse is in close contact with the patient where the nurse can
meticulously assess the fourteen basic human needs of the patient.
Before formulating a plan of care or the care function the you would be administering, it
would be best to assess the patient’s ability to perform the fourteen basic human needs to be able
to know which of the fourteen basic human needs the patient is lacking in. This is a vital step to
116
ensure the best function that the nurse would carry out, if the nurse would perform as a helper, a
doer or substitute, or a partner to the patient.
Henderson identified three levels of nurse-patient relationships in which the nurse acts as
the following:
 A substitute for the patient – doing for the patient (substitutive)
 A helper to the patient – helping the patient (supplementary)
 A partner with the patient – working with the patient (complementary)
Henderson conceptualized the nurse’s role as assisting the sick or healthy individuals to
gain independence in meeting fundamental needs.
Virginia Henderson’s fourteen basic needs include:
 Breathe normally.
 Eat and drink adequately
 Eliminate body wastes
 Move and maintain desirable posture
 Sleep and rest
 Select suitable clothes-dress and undress
 Maintain body temperature within normal range by adjusting clothing and modifying the
environment
 Keep the body clean and well groomed and protect the integument
 Avoid danger in the environment and avoiding injuring others
 Communicate with others in expressing emotions, needs, fears, or opinions
117
 Worship according to one’s faith
 Work in such a way that there is a sense of accomplishment
 Play and participate in various forms of recreation
 Learn, discover or satisfy the curiosity that leads to normal development and health and
use the available health facilities
Virginia Henderson’s Need Theory connects to the patient in a way that most of the fourteen
basic needs by Henderson were given attention and consideration and with this, the group was able
to formulate and provide a plan of care based on the assessed needs of the patient. The patient for
the most part has already met most of the fundamental needs and the group was there to help him
attain the fundamental needs that he was not able to attain on his own.
The group was a helper when they helped with interventions in the prevention of infection and
in bettering the patient’s nutrition. As the group was assessing the patient, asking how he was
feeling and what his concerns were it would then help the group formulate and plan out a desired
outcome and a set of interventions to apply to the patient. The group was a substitute or a doer
when the group performed independent nursing actions and interventions to further better the
health of the patient consequently that the patient would reach her optimum level of health. The
group also performed as a partner in giving care and with the cooperation of the patient the group
was able to help the patient reach her optimum level of health
To conclude, this theory may be related to the group’s patient because the group had to properly
assess the patient for them to formulate a nursing diagnosis on the priority needs of the patient and
interventions that the group can do for the benefit and betterment of the health of the patient.
Virginia Henderson’s theory also relates to the patient for the reason that there were multiple
occurrences that the group performed as a substitute, helper and partner to the patient.
118
Sister Callista Roy’s Adaptation Model
“Nursing is the science and practice that expands adaptive abilities and enhances person and
environment transformation.”
According to Sister Callista Roy's model, a person is a bio-psycho-social being in constant
interaction with a changing environment. He or she uses innate and acquired mechanisms to adapt.
There is a feedback cycle of input (stimuli), Throughput (control processes), and output (behaviors
or adaptive responses).
There are four modes of adaptation:
Physiologic-Physical Mode: Physical and chemical processes involved in the function and
activities of living organisms; the underlying need is physiologic integrity as seen in the degree of
wholeness achieved through adaptation to change in needs.
Self-concept- Group Identity Mode: Focuses on psychological and spiritual integrity and
sense of unity, meaning, and purposefulness in the universe.
119
Role Function Mode: Roles that individuals occupy in society, fulfilling the need for social
integrity. It is knowing who one is in relation to others.
Interdependence Mode: The close relationships of people and their purpose, structure and
development individually and in groups and the adaptation potential of these groups.
The relation of Sister Callista Roy’s Adaptation Model to the patient is that the group looks
at our patient as a constantly adapting individual. An individual in the sense that the patient is
adapting to the four modes that this theory has previously enumerated which are physiologic-
physical mode, self-concept group identity mode, role function mode and lastly the
interdependence mode.
The patient is adapting physiologically and physically because the patient’s body is
ongoing a change after being admitted in the hospital where he is on the road to the optimum health
that his current state permits. His body is transitioning from being sick to the point of being
admitted to the hospital to being better and ultimately be given a may go home order when the
doctor permits it which would then let him continue his role as a father and as a husband. The
patient is ongoing a healing process from his treatment, so his body is adapting in that sense where
it adapts to the change that the body is undergoing and is currently in the process of adapting and
the way that the body adapts is through healing.
For role function, an example of that is the fact that our patient is now adapting the role of
becoming sick and not being able to continue his role which is a husband and father who tends to
his family’s needs and helps around the house and other family matters. The patient is adapting
with his current condition where he has been diagnosed with Pulmonary Congestion he is now
adapting to the new treatment and medications that he has to take and undergo. The patient is also
120
adapting in the sense that he has to adjust his time to be able to cater to his personal needs and
other appointments prior to his admission.
To sum it up, the patient is undergoing physiological and physical change due to the
medications and treatment also going through role change in the sense that he can not tend to his
family since he is currently hospitalized.
121
XVII. NURSING CARE PLANS
Date, Shift Assessment Need Nursing Diagnosis Plan Intervention Evaluation

& Time
September 3, Subjective : At the end of our Independent GOAL MET
2018 “Grabe talaga A Ineffective Airway shift, the patient 1.Assess changes in BP,
tong ubo ko, C Clearance related to will be able to HR, and temperature.
7:00-3:00 nahihirapan T increased sputum maintain a clear, R: Tachycardia and At the end of our
PM akong huminga I production in open airway as hypertension may be shift, the patient
dahil saking V response to evidenced by related to an increased was able to have
9:00 AM plema, ” as I respiratory infection normal breath work of breathing. As the clear lung
verbalized by T sounds, normal hypoxia and/or sounds, and was
the patient. Y rate and depth of hypercapnia become able to breathe
Rationale: respiration. severe, BP and HR drop. normally.
Objective: & Ineffective airway Fever may develop in
-Copius clearance is present response to retained
secretions noted E when the patient has secretions.
-Crackles heard X the inability to clear
on bilateral lung E secretions or 2.Assess respirations:
fields R obstructions from note the quality, rate,
-RR of 26 cpm C the respiratory tract rhythm, nasal flaring, and
I maintain a clear any increased use of
S airway himself. accessory muscles of
122
E respirations.
R: These abnormalities
P indicate a respiratory
A compromise. An increase
T in respiratory rate and
T rhythm may be a
E compensatory response to
R airway obstruction. The
N breathing pattern may
alter to include the use of
accessory muscles to
increase chest excursion.
3.Auscultated the lungs,

noting areas of decreased
ventilation and for the
presence of adventitious
breath sounds.
R: Decreased or absent
breath sounds may
indicate the presence of a
mucus plug or other
123
airway obstruction;
wheezing may indicate
partial airway obstruction
or narrowing coarse
crackles and/or rhonchi
may indicate the presence
of secretions along larger
airways.
4.Assist the effectiveness

of cough. Observe the
color, consistency, and
quantity of secretions.
R : Abnormalities may be
a result of infection,
bronchitis, long term
smoking, or other
conditions. A sign of
infection is discolored
sputum. Thick, tenacious
secretions increase
hypoxemia and may be
124
indicative of dehydration.
5. Encouraged the client

to cough out secretions. If
cough is ineffective,
Institute suctioning of the
airway as needed.
R: Coughing is the most
helpful way to remove
most secretions. The
client may be able to
perform independently.
Suctioning removes
secretions if the client is
unable to effectively clear
the airway. Frequent
suctioning should be
based on the client’s
clinical status, not on a
present routine, such as
every hour. Over
suctioning can cause
125
hypoxia and injury to
bronchial and lung tissue.
6. Transport the client

with portable oxygen,
Ambu bag, suction
equipment, and extra
tracheostomy tube.
R : Being prepared for an
emergency helps prevent
future complications.
7.Provide instruction in
sterile tracheostomy care
and suctioning.
R :This information
enables the client to take
control of his or her life.
Long-term care may be
the client’s responsibility.
Clearly, focused teaching
126
allows the learner to
concentrate more
completely on the
material being discussed.
The client or caregiver
can begin to acquire skills
at a pace that is not
overwhelming.
8.Instructed the patient in

the need to call health
care provider if the
amount of secretions
increases or a change in
color or characteristic
occurs.
R :Changes could signify
the presence of an
infection.
127
Date,
Shift & Assessment Need Nursing Plan Intervention Evaluation
Time Diagnosis
September Subjective: A Impaired Gas After 6 Independent: GOAL MET
3, 2018 “Di ko kahinga ug C Exchange hours of 1.Positioned patient in a semi-
tarong kung naka T related to nursing fowler’s position (45 degrees when After 6 hours of
7-3 PM baba ang uluhan sa I collection of intervention, supine) nursing
akong kama.” As V mucus in the patient R: This allows increased thoracic intervention,
8:30 AM verbalized by the I airways will be able capacity and increased lung the patient was
patient T to: expansion preventing the able to:
Y Rationale: -Maintain abdominal contents from -maintained
Objective: Gas is clear lung crowding. clear lung fields
-Patient on MHBR & exchanged fields and and remains
-Patient has one between the remains free 2.Checked the patient’s position so free signs of
pillow at the back E alveoli and signs of that the patient does not slump respiratory
-Patient O2 @ 2-4 X pulmonary respiratory down in bed. distress by
LPM E capillaries via distress. R: Slumped positioning causes the positioned
-RR of 26 cpm R diffusion. -Participates abdomen to compress the patient in semi-
C in diaphragm and limits full lung fowler’s
I procedures expansion. position and
S to optimize 3. Monitored oxygen saturation. maintained
E oxygenation R: Partial pressure of arterial oxygen
128
in oxygen has been shown to increase administration.
P management in the prone position, because of -Participated in
A regimen the greater contraction of the procedures to
T diaphragm. optimize
T oxygenation in
E 4. Demonstrated and educated the management
R patient in deep breathing and regimen
N perform controlled cough. through deep
R: This technique can help increase breathing and
sputum clearance and decrease controlled
cough spasms. Controlled cough
coughing uses the diaphragmatic demonstrations.
muscles, making the cough more
forceful and effective.
5. Encouraged the significant other

to assist the patient with
ambulation.
R: Ambulation facilitates lung
expansion, secretion clearance, and
stimulates deep breathing.
129
Dependent:
6.Maintained an O2 administration
device as ordered by the physician.
R: Supplemental oxygen is
required to maintain PaO2 at an
acceptable level.
7.Encouraged slow deep breathing

using an incentive spirometer as
ordered by the physician.
R: This promotes deep inspiration,
which increases oxygenation.
8.Administered medications as
prescribed by the physician.
R: The type depends on the
etiological factors of the problem.
(e.g., antibiotics for pneumonia,
analgesics for thoracic pain)
130
Date,
Shift & Assessment Need Nursing Plan Intervention Evaluation
Time Diagnosis
September Subjective: C Acute Pain After 6 hours Independent: GOAL MET
3, 2018 “Sakit kaayo O related to of nursing 1.Encouraged the significant other After 6 hours of
mulihok-lihok labaw G respiratory intervention, to provide rest periods to promote nursing
7-3 PM na kay lisod maka N distress the patient relief, sleep and relaxation. intervention,
ginhawa.” As I will be able R: Pain may result in fatigue, the patient was
8:30 AM verbalized by the T Rationale: to: which may result in exaggerated able to:
patient. I The unpleasant -Verbalize pain. A peaceful and quiet -Verbalized
V feeling of pain is satisfactory environment may facilitate rest. satisfactory
Pain scale of 9/10 E highly pain control pain control by
Objective: - subjective in -Displays 2. Discussed and taught the improving the
-Patient is restless P nature that may improvement significant other to foresee the pain scale to
-Alteration in sleep E be experienced in mood need for pain relief. 7/10
pattern R by the patient. -Displays R: Preventing pain is one thing that -Displayed
-RR: 26 cpm C improved a patient experiencing it can improvement in
E condition consider. Early intervention may mood by being
P such as decrease the total amount of able to sleep
T baseline for analgesic required. -Displayed
U pulse, BP 3. Encouraged the significant other improved
A and to acknowledge reports of pain condition such
131
L respirations immediately. as having an
R: One’s perception of time may average
P become distorted during painful respiratory rate
A experiences. An immediate of 22-24 cpm.
T response to reports of pain may
T decrease patient’s anxiety.
E
R 4. Encouraged the significant other
N to get rid of additional stressors or
sources of discomfort whenever
possible.
R: Patients may experience an
exaggeration in pain or a decreased
ability to tolerate painful stimuli if
environmental, intrapersonal, or
intrapsychic factors are further
stressing them.
5. Determined the appropriate pain

relief method.
R: Patient’s with acute pain should
132
be given analgesic around the
clock unless contraindicated.
6. Taught and demonstrated to the

significant other cognitive-
behavioral strategies such as:
relaxation exercises and breathing
exercises.
R: Increasing one’s concentration,
these techniques help an individual
decrease the pain experience.
Breathing modifications and nerve
stimulations are some of the
methods. The aim of these
techniques is to lessen the stress,
tension, subsequently decreasing
the pain.
Dependent
7. Administer and educate patient
about medications as ordered by
the physician.
133
R: This promotes safe and effective
medication administration.
134
Date,
Shift &
Assessment Need Nursing Plan Intervention Evaluation
Time
Diagnosis
September Subjective: H Hyperthermia After 2 hours of nursing 1. Monitor patient’s GOAL MET.
4, 2018 related to interventions, the patient temperature (degree
“Pabalik-balik yung E After 2 hours
increased shall and pattern), note
lagnat ko, simula pa of nursing
A metabolic rate shaking chills/profuse
nung naadmit ako,”  Demonstrate intervention
7AM- secondary to diaphoresis
as verbalized by L temperature the client was
3PM presence of
patient. T within normal R: Temperature of able to:
bacterial
range, from 38.2 38.9-41.1°Csuggest
H infection - have a body
°C to 36.5°C- acute infectious disease
temperature of
Objective: 37.5°C process
37.5 C, and
 Temperature: P  Identify
Definition: 2. Note presence or verbalize
38.2 C underlying
absence of sweating as understanding
E Presence of
 Flushed skin, cause/contributing
body attempts to of
microorganisms
warm to R factors and
increase heat loss by interventions
stimulates the
touch importance of
C evaporation.
release of
 HR: 112 treatment
E pyrogen from R: Evaporation is
 Verbalize
the leukocytes decreased by
P understanding of
resetting the environmental factors
specific
135
T body’s interventions to of high humidity and
thermostat to prevent high ambient
I
febrile level and hyperthermia to temperature as well as
O then there would promote healthy body factors producing
N be activation of environment. loss of ability to sweat

the
- 3. Increase oral fluid
hypothalamus,
intake
H which will result
in increase in R: To support
E
epinephrine and circulating volume and
A tissue perfusion.
norepinephrine,
L vasoconstriction
of cutaneous
T 4. Promote bed rest,
vessels. The
encourage relaxation
H heat will be
skills and diversional
produced as
activities.
peripheral
M
vasodilation R: To reduce metabolic
A results in skin demands/oxygen
flushing and consumption
N
skin is warm to
A touch.
136
G 5. Provide tepid sponge
bath, avoid use of
E
alcohol
M
R: May reduce fever,
E use of ice water/alcohol
N may cause chills,

actually elevating
T
temperature. In
addition, alcohol is very
drying.
6. Promote surface
cooling, loosen clothing
and cool environment
R: Heat is loss by
evaporation and
conduction.
7. Educate patient on
the importance of
adequate fluid intake
137
and protein diet
R: Adequate fluid
intake prevents
dehydration and protein
diet promotes healing.
8. Administer
medications as
indicated to treat
underlying cause, such
as:
-Paracetamol
500mg/tab 1 tab q 6°
R: Paracetamol exhibits
analgesic action by
peripheral blockage of
pain impulse
generation. It produces
antipyresis by
inhibiting the
138
hypothalamic heat-
regulating centre. Its
weak anti-
inflammatory activity is
related to inhibition of
prostaglandin synthesis
in the CNS.
9. Administer
replacement fluids and
electrolytes to support
circulating volume and
tissue perfusion
R: In the presence of
fever, the amount of
water the body loses is
increased causing
dehydration and
electrolyte imbalances.
Replacement fluid and
electrolytes are needed
139
to compensate.
10. Provide information

and involve client in
appropriate community
and national education
programs.
R: To increase
awareness and
prevention of
communicable
diseases.
140
Date,
Shift &
Assessment Need Nursing Plan Intervention Evaluation
Time
Diagnosis
September Subjective: N Risk for After 5 hours of Independent: GOAL MET

4, 2018 Imbalanced nursing
“Wala dyud na siyay U 1.Maintain adequate nutrition to After 5 hours of
Nutrition: Less intervention,
gana mukaon sukod offset hypermetabolic state. nursing
T than Body the patient will
tung una pa,” as intervention,
7AM- Requirements be able to: R: To replenish lost nutrients.
verbalized by the R the patient was
3PM related to -Demonstrate
patient’s wife. I able to:
increased increased
Objective: 2. Elevate the patient’s head and -Demonstrated
T metabolic needs appetite
neck. increased
 Food tray is secondary to -
I
full fever and Maintain/regain R: Keeping the patient’s head appetite
O
 (+) Vomiting infectious desired body elevated for at least 30 minutes through (-)
N process weight after eating keeps the patient vomiting

x 1 episode
from vomiting. episodes
 Body weight A
decreased -Maintained
L
since desired body
3. Provide small, frequent
admission - weight
meals, including dry food (toast,
M crackers) and/or food that are
141
E appealing to the patient.
T R: It may enhance intake even

though appetite may be slow to
A
return.
B
O
4. Provide covered container
L and remove at frequent
I intervals.
C R: Eliminates noxious sights,

and smell from the patient
environment and can reduce
P nausea.
T 5. Assist and encourage oral

hygiene after emesis, after
T
aerosol and postural drainage
E
treatments, and before meals.
R
R: It reduces tastes from the
N patient environment and can
142
reduce nausea.
6. Consider limiting use of milk

products.
R: Milk products may increase

sputum production.
Dependent:
7. Maintain adequate nutrition to

offset hypermetabolic state and
ask the dietary department to
provide a high-calorie, high
protein diet consisting of soft,
easy-to-eat food.
R: This is to replenish lost

nutrient.
143
XVIII. PROGNOSIS
Good Fair Poor Justification
Onset of Illness Patient Button experienced an

episode of chest pain located on the
X right sternal border and rated it
with a 10/10 on the pain scale. He
then decided to go to the nearest
hospital to have himself checked
and then the physician ruled him
for admission for further
management.
Duration of Illness Prior to admission, Button
experienced chest pain for 18
X hours. After further
assessment/diagnostic tests Patient
Button was diagnosed with
Pulmonary Congestion secondary
to Community Acquired
Pneumonia
Precipitating Patient is a smoker for 40 years.
Factors X Patient is reported to consume 1
pack of cigarettes per day. Patient
stated that he is willing to stop
smoking for sake of his health.
Willingness to take Patient “Button” is very
medications cooperative and willing to comply
with all the medications and
X treatments that were prescribed by
the physician, and that because he
144
is aware of its effects and how it
can aid in his recovery. Also,
Button stated that he gives
importance to every word that the
physician says.
Environmental Button’s wife stated that their
Factors home environment is conducive to
X health recovery/maintenance. She
added that their home is suitable
for rest and comfort since there are
adequate resources such as
comfortable bed and adequate food
supply.
Family Support Button stated that his family
especially his wife and children are
all very supportive, he reported that
X they frequently visit in the hospital
and fully supports him physically,
financially and emotionally. He
also stated that most of the hospital
bills was taken care off by his
children.
Total 0 4.6 6.4 Poor:1 X1.6 = 1.6
Fair: 1X2.3 = 2.3
Good: 4X3.0 = 12
Total: 13.5/6 = 2.65 GOOD
Range of Value:
1.0-1.6 = Poor
1.7-2.3 = Fair
2.4-3.0 = Good
145
In this prognosis, it shows a good sign for the client. He was also able to have a checkup
immediately upon having chest pain. He’s also serious in complying with all his medication. He
stated that he gives value to her health. Having a family that fully supports patient physically,
financially, and emotionally. This means that the patient, through medical treatment will be able
to attain a good recovery. The factors related to the prognosis shows that the patient is capable on
therapeutic management on the illness.
146
XIX. DISCHARGE PLAN AND PATIENT’S SAFETY
Exercise/Environment
Start off by getting out of bed and moving around for a few minutes each day. As your
symptoms improve and you have more energy, you can increase your activity. Speak to your doctor
about how much exercise you should do as you recover. Exercising your lungs may also help. You
can do this by taking long slow deep breaths or blowing through a straw into a glass of water. Deep
breathing is also good for clearing the mucus from your lungs: breathe deeply five to ten times and
then cough or huff strongly a couple of times to move the mucus. Ask your doctor if breathing
exercises could help you.
Treatment
Treatment for pneumonia involves curing the infection and preventing complications.
People who have community-acquired pneumonia usually can be treated at home with medication.
Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a
month or more.
Specific treatments depend on the type and severity of your pneumonia, your age and your
overall health. The options include:
 Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to
identify the type of bacteria causing your pneumonia and to choose the best antibiotic to
treat it. If your symptoms don't improve, your doctor may recommend a different antibiotic.
 Cough medicine. This medicine may be used to calm your cough so that you can rest.
Because coughing helps loosen and move fluid from your lungs, it's a good idea not to
eliminate your cough completely. In addition, you should know that very few studies have
looked at whether over-the-counter cough medicines lessen coughing caused by
pneumonia. If you want to try a cough suppressant, use the lowest dose that helps you rest.
 Fever reducers/pain relievers. You may take these as needed for fever and discomfort.
These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and
acetaminophen (Tylenol, others).
147
Hygiene/Health Teaching
Ways to avoid acquiring pneumonia:
 Get a flu vaccine. A flu virus is a common cause of pneumonia, so a yearly flu vaccine
may help you stay well.
 Don't smoke and avoid other people's smoke. Smoke bothers your lungs and makes it
harder for them to fight off infections.
 Keep asthma under control. If you have asthma, follow your treatment plan. You may
need extra medicine to open up your airways.
 Get a pneumonia vaccine. Your healthcare provider may suggest this vaccine if you're 65
or older, have a chronic disease (such as lung, heart, or kidney disease; sickle-cell
anemia; or diabetes), or are getting over a severe illness. You shouldn't get the vaccine if
you're sick or pregnant.
 Stay active. Even a little exercise may help your lungs fight off infections in the future.
Outpatient
If your pneumonia was caused by a virus, time and rest are key to your recovery. Viral pneumonia
usually gets better on its own in 1 to 3 weeks. But your doctor may recommend treatment that
includes:
 Drinking lots of fluids to loosen the gunk in your lungs
 Lots of rest
 Medicines to control your fever (ibuprofen or acetaminophen)
Diet
Here are five things to eat to boost your lung health and reduce your susceptibility to
inflammation:
148
1 Water
Water helps to flush out waste products and moisten the tissues along your respiratory tract.
This helps your lungs and immune system to filter and get rid of foreign particles.
2 Citrus fruits
Eat two servings of these types of fruit daily: oranges, berries, kiwi fruit and papaya. Packed
full of vitamin C, these fruits boost your immune system and help to speed up recovery. They
also contain antioxidants that fight against environmental damage caused by exposure to
foreign particles.
3 Leafy green vegetables
Vitamin E is also present in other food sources, like vegetable oils, nuts, seeds, wheat germ, so
make sure to include these in your diet, too. Eat two servings of leafy greens every day.
4 Oily fish
Fish like salmon that are rich in omega-3 fatty acids are great for your lungs.
5 Probiotics
You can get probiotics in concentrated probiotic drinks like Yakult and also dairy products
such as milk and yogurt. Choose low-fat or non-fat varieties.
149
XX. RECOMMENDATIONS
The Client and the Family
The group would like to make the following recommendations to the client and the family;
always comply with the doctor’s order to speed up his recovery, comply on the medications as
ordered to manage his pain and other symptoms, and to continue giving importance to his health.
The Students
The group would like to make the following recommendations to the upcoming nursing
students who will be attending patients with problem in oxygenation; to administer medications
as ordered, to give the holistic care that the clinical instructors have taught them and to come into
duty stock with the knowledge needed for the entire shift.
The School
The group would like to recommend to the Ateneo de Davao University teachers to
continue providing the excellent quality of education that they have always been giving since time
immemorial and to focus on areas that need improvement.
The Hospital
The group would like to recommend the following to The Southern Philippines Medical
Centre; to continue giving that world class care they have been giving to patients ever since and to
continue improving its facilities for faster recuperation of the patients.
150
XXI. REFERENCES
 Get the Lowdown on Low HDL Cholesterol Levels. (2018). Retrieved from
https://www.verywellhealth.com/what-causes-low-hdl-cholesterol-levels-698078
 Eosinophil Count: Explanation and Risks. (2016). Retrieved from
https://www.healthline.com/health/eosinophil-count-absolute#purpose
 High uric acid level. (2016). Retrieved from
https://www.mayoclinic.org/symptoms/high-uric-acid-level/basics/definition/sym-
20050607
 Charles Patrick Davis, P. (2018). Liver Blood Tests Abnormal Values (High, Low,
Normal) Explained. Retrieved from
https://www.medicinenet.com/liver_blood_tests/article.htm#what_are_the_basic_fun
ctions_of_the_liver
 Van Leeuwen, A., & Poelhuis-Leth, D. (2014). Comprehensive Handbook of
Laboratory and Diagnostic Tests with Nursing Implications (3rd ed.).
 European Respiratory Society/European Lung Foundation. Major respiratory diseases:
pneumonia. In: Loddenkemper R, Gibson GJ, Sibille Y, eds. European Lung White
Book. The First Comprehensive Survey on Respiratory Health in Europe. Sheffield,
European Respiratory Society Journals, 2003; pp. 55–64
 Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of
hypertension: A systematic review. J Hypertens. 2004;22:11–9
 (Ignatavicius, D. D., MS,RN,ANEF, & Workman, M., PhD, RN, FAAN. (2016).
Medical-Surgical)
 (https://en.wikipedia.org/wiki/Sedentary_lifestyle. Retrieved on July 12, 2018)
 Fromer L, Cooper C. A review of the gold guidelines for the diagnosis and treatment
of patients with COPD. Int J Clin Pract 2008; 62: 1219–1236
 Churchill, E. D., & Cope, O. (1929). The rapid shallow breathing resulting from
pulmonary congestion and edema. Journal of Experimental Medicine, 49(4), 531-537.
 ICU Resus Committee. (2013). Prolonged Ventilator Weaning Protocol, Policies and
Procedures,
151
 Wilkins RL, Stoller JK, Kacmarek RM (2009) Egan’s Fundamentals of Respiratory
Care. (9thed.). St. Louis, MI: Elsevier.
 Feldman C, Brink AJ, Richards GA, Maartens G, Bateman ED. Management of
community-acquired pneumonia in adults. South African Medical
Journal. 2007;97(12):1296–1306.
 Community-acquired pneumonia. Brown J Clin Med (Lond). 2012 Dec; 12(6):538-43.
 Review Clinical and economic burden of community-acquired pneumonia among
adults in Europe.Welte T, Torres A, Nathwani DThorax. 2012 Jan; 67(1):71-9.
152

Benjamin Button - 56

Enviado por

Dados do documento

Descrição original:

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Benjamin Button - 56

Enviado por

Direitos autorais:

Formatos disponíveis

XIII.

Date & Time Progress Date &

Medical History: -Serum Crea -To evaluate kidney function in a

-Paracetamol -It is used to relieve mild or

-Used to help lower bad cholesterol

-Azithromycin -Used to treat different types of

-Acetylcysteine -Used for chest pain (unstable

-Co-amixoclav -Used to treat infections caused by

-Will inform -To let the attending physician -Attending

-Follow up chest -Yields information about the -Chest xray

-Isordil 5mg/tab -Used to dilate blood vessels,

Awake, responsive, not

-To include -This is to help doctors evaluate -ALT was

-Plan to increase -Used to help lower bad cholesterol -Atorvastatin

-Plan to start -To prevent heart attacks and -Asked the AP if

Rounds with Dr.

-Start Berodual -Used to treat or prevent -Berodual was

-Norgesic Forte -To help relax certain muscles in -Norgesic Forte

-Follow up -To diagnose a bacterial infection -Sputum cs was

-Imdur 30 -Used to prevent chest pain in -Imdur 30mg/tab

-Clopidogrel 75 -Used to prevent heart attacks and -Clopidogrel was

-Facilitate -Allows the doctor to monitor how -2DECHO was

pH – 7.31 -Give -To relieve symptoms such as -Metoclopramide

(+) Still with mid to

S: (-) Chest pain

-Serum uric -Serum uric acid: To determine

-Suggest repeat - Sodium: To maintain

-Continue meds -To continue cycle -Medications

-Continue -To be updated on the patient’s -Monitoring was

-Refer -For further management -Patient was

-VS every 4 -They determine which treatment -VS was taken

-Decrease -To diagnose a bacterial infection -Berodual neb

-Follow up -Sputum culture

-Discontinue -Since the patient had a reaction to

-Azithromycin -Used to treat different types of -Azithromycin

-Please attach -To follow up sputum cs result -Sputum cs

-Hold -Patient’s cholesterol level is -Atorvastatine

Date Received: August 31, 2018, 6:17 PM

Date Reported and Released: August 31, 2018, 6:19 PM

Results Reference Justification Nursing

6. Assess for history

Hemoglobin 131 g/L 140-180 g/L Hemoglobin’s

Eosinophil 0.05 0.00-0.04 It helps protect the

Date Received: September 1, 2018, 7:22 AM

LIPID Results Reference Range Justification

HDL 0.83 mmol/L 1.00-1.55 mmol/L HDL has an

Date Performed: August 31, 2018 6:59 PM

Results Reference Range Justification

Classification CARDIOVASCULAR AGENT; ANGIOTENSIN II RECEPTOR

Patient & Family Education

 Notify physician of symptoms of hypotension (e.g., dizziness,

Classification CARDIOVASCULAR AGENT; ANTILIPEMIC

Indications or Adjunctive therapy to diet for patients with high triglycerides.

CNS: Headache, paresthesia, dizziness, insomnia.

GI: Dyspepsia, eructation, flatulence, nausea, vomiting, abdominal pain,

Respiratory: Cough, rhinitis, sinusitis.

Special Senses: Earache, eye floaters, blurred vision, conjunctivitis, eye

Urogenital: Decreased libido, polyuria, vaginitis.

Patient & Family Education

 Contact physician immediately if any of the following develops:

Patient & Family Education

 Do not take other medications (e.g., cold preparations) containing